CHAPTER 2 APPENDIX

 

Appendix 2-1 

Definitions

Appendix 2-2 

"Notification of Completion of Construction" (DNR Form 37)

Appendix 2-3 

"Registration of Minor, Nonrecurring Use of Water" (DNR Form 20) and Completed Sample

Appendix 2-4 

Contractors' EEO/AA and Training Notice

Appendix 2-5(A) 

Equal Employment Opportunity is the Law - English

Appendix 2-5(B) 

Equal Employment Opportunity is the Law - Spanish

Appendix 2-6 

Notice Concerning False Statement and Reports (Form FHWA 1022)

Appendix 2-7(A) 

Wage Rate Information (Form FHWA 1495) - English

Appendix 2-7(B) 

Wage Rate Information (Form FHWA 1495A) - Spanish

Appendix 2-8(A) 

Safety and Health Protection on the Job (IOSH 30)

Appendix 2-8(B) 

Family and Medical Leave Act (WH-1420)

Appendix 2-8(C) 

Employee Polygraph Protection Act (WH-1462)

Appendix 2-9 

Reserved for Future Use

Appendix 2-10 

Project Engineer’s EEO Project Site Inspection/Wage Rate Report (Form 650170)

Appendix 2-11 

Listing of Organizations, Agencies, Schools and Newspapers to be Used for Minority Recruitment

Appendix 2-12 

Reimbursable Trainee Training Records (Form 650190)

Appendix 2-13 

Training Time Schedule

Appendix 2-14 

Certified Transcript of Labor Payroll/Statement of Compliance (Form 830176) and Completed Samples

Appendix 2-15 

Traffic Control Non-Compliance Flow Chart

Appendix 2-16 

Subcontract Request & Approval (Form 830231)

Appendix 2-17 

Statement of DBE Commitments (Form 102115)

Appendix 2-18 

Reserved for Future Use

Appendix 2-19 

Certification of DBE Accomplishment (Form 102116)

Appendix 2-20 

Request to Lease Excess Land

Appendix 2-21 

Contract Quantity Agreement (Form 830230)

Appendix 2-22 

Request for Early Release of Retained Funds

Appendix 2-23 

Certification of Subcontractor Payments (Form 518002)

Appendix 2-24 

Statement of Materials & Labor Used by Contractors on Highway Construction Projects Involving Federal Funds – English and Metric (Form FHWA 47 and Form FHWA 47M) Reserved for Future Use

Appendix 2-25 

Contractor's Statement of Sales and/or Use Tax (Form 181321)

Appendix 2-26 

Reserved for Future Use

Appendix 2-27 

Charging of Contract Time

Appendix 2-28 

Weekly Report of Working Days for Incentive/Disincentive Clause (Form 830241)

Appendix 2-29 

Reserved for Future Use

Appendix 2-30 

Classification of Overrun/Underrun Change Orders

Appendix 2-31 

Change Order Authorization Matrix

Appendix 2-32 

Interest Payment Information – Primary & Interstate Projects (Form 830235)

Appendix 2-33 

Noncomplying Tests or Measurements of Material Incorporated into the Project

Appendix 2-34 

 

 

Price Adjustment Tables

 

A -  Aggregate Gradation Test Deviation

B -  Concrete Slump (English and Metric)

C -  Concrete Air Content, Water Cement Ratio, Vibrator Frequency, Certified Plant Inspection, & Late Curing  Application

D - Bridge Floor Resurfacing and Overlay Projects

E - Out-of-Tolerance Tining

F -  Liquid Asphalt Noncomplying Viscosity or Penetration

G - Asphalt Residue Deficiency

H - Asphalt Binder (Noncomplying Dynamic Shear Rheometer)

I -   Asphalt Binder

J -  Filler/Bitumen Ratio

K - Segregation (English and Metric)

L - Steel H-Pile Weight Deficiency

M - Noncomplying (Asphalt Binder) Film Thickness

 

Appendix 2-35 

Fuel Adjustment Worksheet and Sample Calculations – English and Metric

Appendix 2-36 

Reserved for Future Use

Appendix 2-37 

As-Built Adhesive Backed Standard Format Samples:

 

Certification Block (Form 520003)

Extra Work Order Log (Form 520004)

Estimated Project Quantities (100-0) (Form 520007)

Estimated Project Quantities (100-1) (Form 520008)

Check List for As-Built Plan Preparation

Appendix 2-38 

 

SPECIAL INSTRUCTIONS FOR LOCAL AGENCIES:

 

Resolution Authorizing County Engineer to Act on Behalf of Board of Supervisors (Counties Only)

Interest Payment on City/County Projects

Liquidated Damages

Audits by DOT on Federal-Aid Projects

Forms for Final Payment Packet

Farm to Market Form Submittal Instructions

Interest Payment Data Form

Value Engineering for Local Projects